Am I good enough for psych?

[Ambivalentmedstud2]

Hello everyone,
I am an M3 currently interested into psych with a close second choice IM. I have always had an interest in whole person care. Throughout my rotations, I have done very well in psych, getting comments that I was compassionate, had a good understanding of the DSM and pharmacology. At the same time, at all other rotations, I have had people constantly saying that my skillset and reasoning is very suited to IM (even the surgery and ob people).

I am currently doing an elective in psychodynamic therapy and I absolutely fell in love. The ability to sense human suffering and to understand the pathopsychology, not just the symptoms, was fascinating. To this point, I see myself having a half practice of therapy and pharmacology.

Yet, the only worry in my mind is that I am not cut for psych. I am able to connect with patients, however in my own life I felt that I always had a little bit of difficulty interacting with people. I am introverted, have fewer friends than your average person, feel disconnected from the rest of my class, I am less attentive to social cues and I find that I can easily drift off when holding a conversation for too long. I sometimes feel like meeting friends is a chore (but it's much better once I actually interact with them) (maybe due to fatigue with medical school?). I am very bad at superficial talk, but once I have somewhere where I can discuss philosophy, politics and human nature, both of us have an extremely meaningful connection.


I know that residency training is supposed to hone those aspects, but I am afraid that I am not a psychiatrist material to begin with. If I want to do something for a career, I want to do great in it. I know I only gave a very limited view of myself, but I would love to hear about this forum's thoughts on my decision.

I wanted to know if many people here have had a similar experience as I did. If so, how did you manage to overcome this and how did it work out for you?

I would also have additional questions, which have been debated in this forum quite a while, but I suppose it doesn't hurt to relaunch the discussion:

1) How do you see the future of psychotherapy? Do you think the increasing emphasis of pharmacology means we are focused more on symptoms management rather than addressing the etiology of the suffering and increasing the patient's capacity to tolerate?
2) How do you think artificial intelligence will play in the field?
3) How do you see the field in 20 years?

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[MacDonaldTriad]

If you have true passion for therapy and mentors have told you you're good at it, you are probably good at it. Being a good psychiatrist has a lot to do with listening and nothing to do with small talk. Unless your psychiatric mentors are clueless, they are probably right in their assessment of you. I think pharmacological interventions has peaked, proven to not be the end all and I think the pendulum will swing back in the therapy direction for a while. AI is much more likely to replace algorithm based medicine like IM than it will be capable of supplanting psychiatry. I loath check list psychiatrists. I think psychiatry has gone gang busters over the last two decades and the future looks promising with no end in sight.

 

[ziggyhope]

To address your questions:

1.) It is hard to say in psychiatry since there is so much flexibility, but if you want to practice as you described, you'll be able to find a job, two 1/2 jobs, or four 1/4 jobs that will suit you.
2. )Love AI discussion, if anyone wants a good and entertaining read regarding AI, go here: Wait But Why. I agree with @MacDonaldTriad, psychiatry will probably be last to be replaced, unless said super AI develops new medications that cure all psychiatric illnesses, in which case we may not be needed at all, lol.
3. ) No idea, but future looks bright right now with a lot of options, looking forward to practicing during said 20 years and beyond.

Regarding your personal qualities, psychiatrists come in all shapes and forms, a clinical interview is very very different than "small talk", psychotherapy is not just "catching up" with your patients. You will learn all of these skills in residency, whether you translate some of them to your personal life, well that's up to you. In summary, if you love psych, go into psych, you will be fine, we are very welcoming.

 

[Fan_of_Meehl]

Plenty of introverts who have had to overcome a little social anxiety and self-focused attention go on to make fantastic psychiatrists or psychologists. In fact, I'd go so far as to say that it's a natural fit. I would also agree that mental health treatment will be one of the areas most robust against the threat of being automated. Algorithms and heuristics are useful, but only in context and only as tools that still require an artisan to use them. Eliminative materialism and biological reductionism are also useful---to a point, but have never fully replaced human reasoning and individual clinician judgment or other models of understanding psychopathology such as contextual-behavioral, cognitive-behavioral, interpersonal, dialectical-behavioral, behavior-analytic, and quite a few other hyphenated (or not) approaches.

 

[aim-agm]

Speaking as a fellow introvert who wants to go into psychiatry, for whom IM as a second choice, has been told good things about psych skills but is also performed very well in IM...I think you'll be fine. PM me if you want to talk further.

 

[TexasPhysician]

Being great at anything will require a lot of practice and training. For now, just work on what field would make you the happiest. The rest will come if you put your mind to it.

 

[Attending1985]

Being great at anything will require a lot of practice and training. For now, just work on what field would make you the happiest. The rest will come if you put your mind to it.

Very well said. Pick what you want to do not what you’re good at. You can get good at anything if you want to. Adopt a growth mindset and go towards what you want not away from what you’re afraid of.

 

[hamstergang]

Yet, the only worry in my mind is that I am not cut for psych. I am able to connect with patients, however in my own life I felt that I always had a little bit of difficulty interacting with people.

If you're fine with patients, why would it matter that you struggle in social situations? Your job as a psychiatrist is to treat patients not make friends, so it seems like you're all set. There's nothing to overcome here.

 

[Ambivalentmedstud2]

Thank you everyone for your support. This definitively wants me to apply to psych even more.

 

[Attending1985]

Regarding number one in my experience the standard job offer in an employed position is a 20-30 minute med check and 40-60 minute evaluation. I have not received any job offers from employers who allow psychotherapy. If you work in a severely underserved area and they are desperate enough you can try to negotiate for it. Otherwise, you can do whatever you want in private practice but have to get your own health insurance, life insurance, disability insurance, malpractice insurance, retirement, ect.

 

[UTsksk]

The whole thing about being introvert vs extrovert reminds me of a convo I had with another applicant while we waited for our flight. They were applying FM also and they asked if all psych people are awkward at the interview dinners. I guess they saw how psych applicants acted vs FM applicants. To be honest, I didn't notice awkwardness but I guess people were a little guarded. I asked plenty of questions. Maybe I wasnt guarded enough since I didn't match there.

The point is I think psych is definitely one of the fields where introverts and extroverts work well.

 

[TexasPhysician]

Otherwise, you can do whatever you want in private practice but have to get your own health insurance, life insurance, disability insurance, malpractice insurance, retirement, ect.

I’ll give you that health insurance takes a bit of effort each year to choose a plan. Employed docs just accept whatever the company provides.

Many employers don’t provide enough term life insurance anyway, but regardless of who you are, term life is cheap and all companies are compared against each other on 1 site. Choosing a plan and applying will likely take you less than 2 hours 1x for 15-20 year coverage.

Disability insurance should be occupation specific. Most employers provide cheap generic disability coverage that is not sufficient. Everyone should buy their own supplemental plan.

Malpractice insurance is easy to apply for and keep. After finding a company (recommended by peers), you can set up auto draft and forget it.

Retirement plans are significantly better for self-employed individuals. Plus all of the tax deductions. As you get older, you can even design your own pension (defined benefit) plan like the VA.

 

[Georgit]

I sometimes feel like meeting friends is a chore

I usally use this as definition of an introvert. We lose energy when with others, and regain it staying alone.
But I have excellent relationship with co-worker and good with clients. It's somehow related with the more rigid setting of workplace whereas I feel a bit lost in the open field of friendship.
Bottom line, so I think you could feel confortable inside the therapeutic relationship.